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Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 37 Care of Patients with Cardiac Problems.

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Presentation on theme: "Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 37 Care of Patients with Cardiac Problems."— Presentation transcript:

1 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 37 Care of Patients with Cardiac Problems

2 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 2 Heart Failure  Also called pump failure, general term for the inability of the heart to work effectively as a pump  Left-sided heart failure  Right-sided heart failure  High-output failure

3 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 3 Left-Sided Heart Failure  Typical causes—hypertensive, coronary artery, valvular disease  Formerly known as congestive heart failure  Two types of left-sided heart failure:  Systolic heart failure  Diastolic heart failure

4 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 4 Right-Sided Heart Failure  Typical causes—left ventricular failure, right ventricular MI, pulmonary hypertension  Right ventricle not able to empty completely  Increased volume and pressure in the venous system and peripheral edema

5 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 5 High-Output Failure  Cardiac output remains normal or above normal  Caused by increased metabolic needs of hyperkinetic conditions such as:  Septicemia  Anemia  Hyperthyroidism

6 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 6 Compensatory Mechanisms  Sympathetic nervous system stimulation  Renin-angiotensin system (RAS) activation  Other chemical responses:  B-type natriuretic peptide (BNP)  Myocardial hypertrophy

7 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 7 Etiology  Heart failure is caused by systemic hypertension in 75% of cases.  About one third of patients experiencing myocardial infarction also develop heart failure.  Structural heart changes, such as valvular dysfunction, cause pressure or volume overload on the heart.

8 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 8 Left-Sided Heart Failure  Manifestations include:  Weakness  Fatigue  Dizziness  Confusion  Pulmonary congestion  Breathlessness

9 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 9 Left-Sided Heart Failure (Cont’d)  Oliguria  Death

10 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 10 Right-Sided Heart Failure  Manifestations include:  Distended neck veins, increased abdominal girth  Hepatomegaly (liver engorgement)  Hepatojugular reflux  Ascites  Dependent edema  Weight—the most reliable indicator of fluid gain or loss

11 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 11 Assessments  Psychosocial assessment  Laboratory assessment  Imaging assessment  Electrocardiography  Pulmonary artery catheters

12 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 12 Impaired Gas Exchange  Interventions include:  Ventilation assistance  Position  Oxygen

13 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 13 Decreased Cardiac Output  Interventions include:  Improved and increased cardiac pump effectiveness  Hemodynamic regulation  Drugs that reduce afterload—ACE inhibitors, ARB, human B-type natriuretic peptides

14 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 14 Interventions That Reduce Preload  Nutrition therapy  Drug therapy—diuretics and venous vasodilators  Drugs that enhance contractility—digoxin, other inotropic drugs, beta-adrenergic blockers

15 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 15 Treatment of Congestive Heart Failure

16 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 16 Other Nonsurgical Options  Continuous positive airway pressure  Cardiac resynchronization therapy  Gene therapy

17 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 17 Surgical Management  Heart transplantation  Ventricular assist devices  Other surgical therapies:  Partial left ventriculectomy  Endoventricular circular patch  Acorn cardiac support device  Myosplint

18 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 18 Heart Transplantation

19 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 19 Activity Intolerance  Interventions include:  Balance activity and rest.  Nap to restore energy.  Recognize energy limitations.  Conserve energy.  Adapt lifestyle to energy level.  Report adequate endurance for activity.

20 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 20 Potential for Pulmonary Edema  Interventions include:  Assess for early signs, such as crackles in the lung bases, dyspnea at rest, disorientation, and confusion.  High-Fowler’s  Oxygen therapy  Nitroglycerine, rapid-acting diuretics, IV morphine sulfate  Continual assessment

21 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 21 Community-Based Care  Home care management  Health teaching  Health care resources

22 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 22 Heart Valves

23 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 23 Valvular Heart Disease  Mitral stenosis  Mitral regurgitation (insufficiency)  Mitral valve prolapse  Aortic stenosis  Aortic regurgitation (insufficiency)

24 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 24 Assessment  Patient may become suddenly ill or slowly develop symptoms over many years.  Question patient about attacks of rheumatic fever and infective endocarditis and about possibility of IV drug abuse.  Obtain chest x-ray, echocardiogram, and exercise tolerance test.

25 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 25 Common Nursing Diagnoses  Decreased Cardiac Output related to altered stroke volume  Impaired Gas Exchange related to ventilation perfusion imbalance  Activity Intolerance related to inability of the heart to meet metabolic demands during activity  Acute Pain related to physiologic injury agent (hypoxia)

26 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 26 Nonsurgical Management  Nonsurgical management focuses on drug therapy and rest  Drug therapy, including diuretics, beta blockers, digoxin, oxygen, and sometimes nitrates  Prophylactic antibiotic  Management of atrial fibrillation  Anticoagulant  Rest with limited activity

27 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 27 Surgical Management  Reparative procedures  Balloon valvuloplasty  Direct, or open, commissurotomy  Mitral valve annuloplasty  Replacement procedures

28 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 28 Heart Valves

29 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 29 Community-Based Care  Home care management  Health teaching  Health care resources

30 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 30 Infective Endocarditis  Microbial infection involving the endocardium  Occurs primarily in patients who abuse IV drugs, have had valve replacements, have experienced systemic infections, or have structural cardiac defects  Possible ports of entry—oral cavity, skin rash, lesion, abscess, infections, surgery, or invasive procedures including IV line placement

31 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 31 Manifestations  Murmur  Heart failure  Arterial embolization  Splenic infarction  Neurologic changes  Petechiae (pinpoint red spots)  Splinter hemorrhages

32 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 32 Diagnostic Assessment  Blood culture  Echocardiography  The most reliable criteria for diagnosing endocarditis include positive blood cultures, a new regurgitant murmur, and evidence of endocardial involvement by echocardiography

33 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 33 Interventions  Antimicrobials.  Anticoagulants are of no value in preventing embolization from vegetations.  Patient’s activities are balanced with adequate rest.

34 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 34 Surgical Management  Removing the infected valve  Repairing or removing congenital shunts  Repairing injured valves and chordae tendineae  Draining abscesses in the heart or elsewhere

35 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 35 Pericarditis  Inflammation or alteration of the pericardium, the membranous sac that encloses the heart  Dressler’s syndrome  Post-pericardiotomy syndrome  Chronic constrictive pericarditis

36 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 36 Pericarditis (Cont’d)

37 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 37 Assessment  Substernal precordial pain radiating to left side of the neck, shoulder, or back  Grating, oppressive pain, aggravated by breathing, coughing, swallowing  Pain worsened by the supine position; relieved when the patient sits up and leans forward  Pericardial friction rub

38 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 38 Interventions  Pain management  Pericardiectomy

39 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 39 Pericardial Effusion  Cardiac tamponade:  JVD  Paradoxical pulse  Decreased CO  Muffled heart sounds  Circulatory collapse

40 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 40 Pericardial Tamponade Copyright © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

41 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 41 Acute Cardiac Tamponade: Emergency Care  Cardiac tamponade—an extreme emergency  Increased fluid volume  Hemodynamic monitoring  Pericardiocentesis  Pericardial window  Pericardiectomy

42 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 42 Pericardiocentesis

43 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 43 Rheumatic Carditis  Sensitivity response that develops after an upper respiratory tract infection with group A beta-hemolytic streptococci  Inflammation in all layers of the heart  Formation of Aschoff bodies, small nodules in the myocardium that are replaced by scar tissue  Impaired contractile function of the myocardium, thickening of the pericardium, and valvular damage

44 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 44 Clinical Manifestations  Tachycardia  Cardiomegaly  New or changed murmur  Pericardial friction rub  Precordial pain  Changes in electrocardiogram  Indications of heart failure  Existing streptococcal infection

45 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 45 Cardiomyopathy  Subacute or chronic disease of cardiac muscle  Dilated cardiomyopathy  Hypertrophic cardiomyopathy  Restrictive cardiomyopathy  Arrhythmogenic right ventricular cardiomyopathy

46 Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 46 Interventions  Drug therapy  Implantable cardiac defibrillators  Toxin exposure avoidance  Alcohol avoidance  Ventriculomyomectomy  Percutaneous alcohol septal ablation  Heart transplantation


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